California launches investigation following stunning admission by Aetna medical director

[southernlady]

https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

During the deposition, the doctor said he was following Aetna's training, in which nurses reviewed records and made recommendations to him.
Jones said his expectation would be "that physicians would be reviewing treatment authorization requests," and that it's troubling that "during the entire course of time he was employed at Aetna, he never once looked at patients' medical records himself."

 

[hilary1617]

Wow.

 

[Munchkin]

Wrong! I hope they are prosecuted.

 

[JackieOnLine]

 

[bearmom]

After some of my insurance issues, I think this may be more widespread than just aetna.

It makes me furious to read that.

 

[k9ophile]

I couldn't get past the first sentence. bearmom I'd bet on that widespread practice by insurance companies and I'm not a gambler, just a cynic.

 

[Spiky Bugger]

https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

MiniSue had Aetna, wore a 36J (yes, J) bra, and decided that the time had come to do something about that massive problem.

Aetna denied.

We did something rather informal, but then got a written denial of the amount of surgery* she--and FIVE in-network, board certified plastic surgeons--wanted, signed by the Aetna in-house doctor. I checked his credentials. He was an otolaryngologist.

I wrote a letter. Boy! Did I write a letter. The day they received it, they called. No, of COURSE they didn't want to proceed to the CA Dept of Managed Health Care, there must be SOME mistake, of COURSE her surgery is pre-approved.

Moral of the story...the wrong doctor has the potential to be as bad as no doctor.


*silly girl, she--and the plastic surgeons--thought goung from a 36-J to a 36-C would be nice. Aetna was insisting on something that would leave her a 36-A. Really? No.